Perioperative changes in lung re-transplantation: a single-centre observational study

Reports describing the management of lung re-transplantation (Re-LTx) are lacking. Therefore, this study evaluated the characteristics of Re-LTx to guide perioperative management.

This study retrospectively analysed the clinical data of patients who underwent primary lung transplantation (primary-LTx) and Re-LTx in the First Affiliated Hospital of Guangzhou Medical University from 2016 to 2023. The key perioperative changes after Re-LTx (primary outcome) and the short-term postoperative rehabilitation characteristics (secondary outcome) were evaluated.

The study included 26 patients who underwent primary LTx who were propensity score-matched (1:2) with 13 patients who underwent Re-LTx. The preoperative Acute Physiology and Chronic Health Evaluation (APACHE) score was higher in the Re-LTx group (P=0.001). The intraoperative conditions, incidence of postoperative extracorporeal membrane oxygenation (ECMO) support, intensive care unit (ICU) stay, duration of postoperative hospital stay, total hospital stay, and complications on postoperative day seven did not differ between the groups (P>0.05). However, the intraoperative haemoglobin and fibrinogen levels were lower (P=0.002 and P=0.03, respectively), and the blood urea nitrogen and serum creatinine levels were higher in the Re-LTx group (both P<0.001). The pH, arterial oxygen pressure, partial pressure of carbon dioxide, and haemodynamic values did not differ between the groups (P>0.05).

The perioperative management of Re-LTx may be similar to that of primary LTx based on comparable intraoperative conditions and postoperative rehabilitation characteristics. However, patients undergoing Re-LTx were prone to renal dysfunction and intraoperative anaemia.